Clinical Quality Manager

HealthFirst•New York, NY

7d•$73,400 - $120,360•Remote

About The Position

The Clinical Quality Manager works with members and providers to ensure members receive appropriate services. This role emphasizes improving the quality of care with a focus on HEDIS, QARR and Medicare Advantage Star measures.

Requirements

Members and providers to ensure members receive appropriate services
Improving the quality of care with a focus on HEDIS, QARR and Medicare Advantage Star measures
Reviews billing codes, medical records, and claims submission process to ensure accuracy
Attends and facilitates any initiative meetings (studies, partnerships) that involve targeted providers and/or measures.
Completes on-site visits on a regular basis to implement the work plan and to conduct provider education sessions regarding appropriate coding practices and chart documentation.
Collaborates with other departments to maximize member outreach for preventive services and chronic disease management.
Assists in writing member and/or provider articles in relation to HEDIS, QARR, Medicare Advantage and/or health promotions for HF newsletter.
Supports regulatory affairs, as deemed necessary by management.
Documents all relevant interactions in appropriate systems

Responsibilities

Interacts with hospitals, providers, and members to improve quality of care, monitor progress, and recommend changes
Reviews billing codes, medical records, and claims submission process to ensure accuracy
Attends and facilitates any initiative meetings (studies, partnerships) that involve targeted providers and/or measures.
Completes on-site visits on a regular basis to implement the work plan and to conduct provider education sessions regarding appropriate coding practices and chart documentation.
Collaborates with other departments to maximize member outreach for preventive services and chronic disease management.
Assists in writing member and/or provider articles in relation to HEDIS, QARR, Medicare Advantage and/or health promotions for HF newsletter.
Supports regulatory affairs, as deemed necessary by management.
Documents all relevant interactions in appropriate systems
Additional duties as assigned